Obesity: another lecture at the surgery
A new study claims that patients will not be offended by doctors telling them they are overweight and offering to send them on a weight-loss course. The study, published in the Lancet, randomly assigned overweight patients to one of two outcomes: either they were offered a weight-loss course or they were given advice that they should lose weight. In both instances, the process was designed to take the GP no more than 30 seconds, easing concerns that discussing a patient's weight would take up an inordinate amount of time in time-pressured consultations.
Was it a success? Among those offered the course, there was an average weight loss of 2.43kg. For those merely offered advice, there was still a reduction in weight, but it was only just over 1kg on average. The paper concludes: 'A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight.'
Well, that's one way of looking at it. True, many people who are overweight would like to lose some of that spare tyre, so being offered a free weight-loss course on the NHS (in this case, Weight Watchers or similar) would be very welcome. So yes, the offer of free stuff can be 'acceptable'. But the problem is that lecturing patients about lifestyle has become so routine that the thing that brought them to the surgery in the first place often gets relegated to an afterthought. This is particularly true for smokers, who can expect to be nagged and directed towards NHS Stop Smoking Services on a regular basis.
The threat of a lecture can also lead patients to start lying to their doctors. Rather than have an honest conversation about lifestyle, both doctor and patient will skirt around the issues, even if they're important. Who wants to be told that they are Doing Something Bad? Easier to tell a little lie than have your ear bent - yet again.
Moreover, the claims made for the success of this new intervention should also be taken with a pinch of salt. The difference in weight loss between those who attended a weight-loss course and those who did not were not, on average, particularly impressive: 1.43kg. Does such a small amount of weight loss have any effect on health? And it seems unlikely that such weight reductions were maintained in the long run except in those who, for quite separate reasons, are motivated to keep up the calorie counting and activity schedule.
Unless we have gone to our doctors for 'a medical' - an event intended to be an evaluation of our health generally - it would be better if doctors laid off the lifestyle advice and concentrated on dealing with whatever ails us. That would lead to a more helpful and healthy relationship between doctor and patient.